Provider Demographics
NPI:1114176716
Name:NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY, INC.
Entity Type:Organization
Organization Name:NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY, INC.
Other - Org Name:NORTH COUNTRY HOME HEALTH AGENCY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:603-444-5317
Mailing Address - Street 1:536 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4120
Mailing Address - Country:US
Mailing Address - Phone:603-444-5317
Mailing Address - Fax:603-444-0980
Practice Address - Street 1:536 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4120
Practice Address - Country:US
Practice Address - Phone:603-444-5317
Practice Address - Fax:603-444-0980
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH COUNTRY HOME HEALTH & HOSPICE AGENCY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-18
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02236251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99591017OtherMEDICAID HCBC
NH301518OtherMEDICARE/HOSPICE
NH80307009Medicaid
NH301518OtherMEDICARE/HOSPICE
NH99591017OtherMEDICAID HCBC